Perioperative indicators of stress response and postoperative inflammatory complications in patients undergoing off-pump coronary artery bypass surgery: a prospective observational study.
BACKGROUND
Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed.


RESULTS
The study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index.


CONCLUSIONS
Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored.
Song
Suk-Won
SW
Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University Health System, Republic of Korea.
Yi
Gijong
G
Lee
Sak
S
Youn
Young-Nam
YN
Sul
Soon-Young
SY
Yoo
Kyung-Jong
KJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000097:blood / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D018836:Inflammation Mediators / Q000097:blood; D007958:Leukocyte Count; D008171:Lung Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011300:Preoperative Care; D011446:Prospective Studies; D013312:Stress, Physiological; D013530:Surgical Wound Infection / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D013997:Time Factors
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D018836:Inflammation Mediators; C036309:fibrin fragment D; D002097:C-Reactive Protein; D006854:Hydrocortisone